Provider Demographics
NPI:1306371273
Name:PIECORA, KYLE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:PIECORA
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HHC 2ID SBDE
Mailing Address - Street 2:UNIT 15476, BOX #131
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96260-5476
Mailing Address - Country:US
Mailing Address - Phone:0109-557-0127
Mailing Address - Fax:
Practice Address - Street 1:HHC 2ID SBDE
Practice Address - Street 2:UNIT 15476, BOX #131
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96260-5476
Practice Address - Country:US
Practice Address - Phone:0109-557-0127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4815103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical